HomeContact UsDirections
   
Obituaries
StaffServicesHistoryResourcesGrief SupportContact Us LeftLinks

Elgin, NE
107 Pine Street
Elgin, NE
Zip: 68636
(402) 843-5400

Clearwater, NE
404 S. 2nd St.
Clearwater, NE
Zip: 68726
(402) 485-2503


 

Prearrangement means you can express your individuality in a funeral service.

This is done by making all the necessary arrangements now for a service the way you would like it. Plans can be tailored to suit individual needs.

For specific information about this service or any other related funeral questions, we are available for appointments either in your home or at our facilities. You may call or write for information. Advance planning makes good sense, and is an economically sound decision. For additional information, please call.

To begin the process of advance planning please fill out the below form.
Fields marked (*) are required

Personal Information
Name:*
  Date of Birth:*
  Place of Birth:*
         
Address:*
  City:*
  State:*
         
County:*
  Zip:*
  Telephone:*
         
E-mail:
   Spouse's Name:
   Spouse's Maiden Name:
         
Place of Marriage:
   Date of Marriage:
   Father's Name:*
         
Mother's Name:*
  Mother's Maiden Name:*
   
         

Education/Work History
Education:
         
Occupation:
   Business:
   Company:
 

Military Record
Branch of Service:
   Serial Number:
   Date Enlisted:
         
Rank at Discharge:
   Date of Discharge:
   Discharge On File At:
         
Name of Wars:
   Person In Charge:
   Address:
         
Telephone:
        
         

Funeral Service Request
Place of Service:
   Place of Visitation:
   Religious Denomination:
         
Place of Worship:
   Lodge/Union:
    
         
Person In Charge of Arrangements:
         
Flower Preference:
   Music:
    
         
Casket Bearers (6):
   1.    
         
    2.    
         
    3.    
         
    4.    
         
    5.    
         
    6.    
         
Jewelry:
   Glasses:
    
         
Clothing:
         
Other:
         

Disposition Request
Disposition (Earth Burial, Mausoleum, Cremation):
         
Cemetary:
   Address:
   Phone:
         
Section:
   Last Will/Testament:
(check if yes)		   Location:
         
Other Instructions:
         
Memorials/Donations to Charity:
         
Send information about pre-arrangement:
         
Contact me to set an appointment:
         


 
Home | Obituaries | Staff | Services | History | Local Resources | Grief Support | Contact Us | Links
Copyright 2007 Huffman-Levander Funeral Homes Website Created/Hosted by Applied Connective Technologies